is a life threatening medical - salisbury · what is autonomic dysreflexia? can occur quickly is a...
TRANSCRIPT
Dysreflexia
zFirst described in 1917,
zIt is a protective mechanism that tells the person that something is wrong
zImportant to view it as a positive warning sign
zAlso known as autonomic hyperreflexia,
Who is at risk?
zOccurs in 8385% of tetraplegic and high level paraplegic persons injured (T6 and above)
zIf is going to occur, it usually begins within the first few months following spinal shock
What happens
z SCI results in the nerve pathways to the brain are interrupted.
zWhen there is pain or discomfort below the level of your SCI it triggers a nervous system reflex response
z This begins a rapid increase in your blood pressure
z This will continue until the cause is found and treated
Possible Consequences of AD
z Retinal haemorrhage in the eye z Apnoea breath holding z Stroke z Renal (Kidney) failure z Subarachnoid (Brain) haemorrhage z Seizures (Fits) z Cardiac dysrhythmias (Heart changes) z Cardiac arrest z Death
All are rare
Prevention of AD
zGood personal care
zCareful bladder and bowel management
zGood education
zExpert Patient in control
Most Common Causes?
Research shows that the most common causes are: 1 over distended bladder 2 over distended bowel
(Ceron & RakowskiReinhardt 1991, Dunn 1991, Finocchiaro & Herzfeld 1990, McGuire & Kumar 1986 cited Adsit & Bishop 1995)
Most Common Triggers
zDistended bladder zDistended bowel zSkin breakdown zUTI zOther causes of pain or discomfort
Other Possible Triggers
z Ingrown toenails z External temperature
extremes z Clothing or shoes too tight z Digital stimulation of the
bowel z Bladder spasm and stones z Spasticity z Sphincter bladder
dyssynergia z Appendicitis z Orgasm
z Burns and Sunburn z SIC z Enemas z Fractures z Ovarian cyst z DVT & PE z Perforated gastric ulcer z Heterotrophic Ossification z Orthastic hypotension z Oesophageal reflux
Response to Raised BP
zThe body does try to reduce the BP,
zonly able to do so above the level of injury,
zwhich produces the well recognised symptoms of autonomic dysreflexia
Signs and Symptoms
z Headache sudden & thumping z Flushed face – vasodilitation z Blotching of the skin – erythema z Goose bumps below the level of the lesion z Pallor below the level of the lesion
z Increased blood pressure z Bradycardia z Profuse sweating
z Nasal stuffiness z Fear
Patient Specific Symptoms
Some patients may not experience the common symptoms,
particularly the thumping headache
May complain of a ‘tight chest’ instead
Other Signs and Symptoms
z Increased spasm and spasticity z Nausea z Respiratory difficulties z Heart beat changes z Impending sense of doom z Vision changes z Metallic taste in the mouth
Treatment
Are you at risk of AD? z Level of SCI ? T6 or above z Extent of SCI
?complete/?incomplete z Previous episodes z Usual cause z Post SCI new normal BP
Treatment
z Carers or you need to act quickly & calmly, z Enlist help if needed z Sit upright if in bed (helps to lower BP) z BP monitored every 35 mins in hospital z Loosen tight clothing & binders z Assess for cause – bladder & bowel first z Prepare for catheter change or bowel care
Find Cause: Bladder
zCheck urine in drainage bag yFull, empty and monitor yEmpty, ?when last emptied
zCheck for kinks in tubing zCheck for signs if catheter is dislodged zAny sign of haematurea? zCatheter blocked? Change it
Find Cause: Bowel
zLast bowel care, ? Result – good/small zLie on left side (head raised) zPR check zIf full will need manual evacuation zLocal anaesthetic gel (3 mins) zGentle Manual Evacuation (ME) zLet AD resolve and then perform usual bowel care
Other Cause?
z?Ingrown toe nail z?Pressure ulcer
zGive analgesia z? Give Nifedipine zCall GP, will need treatment and possibly Nifedipine SR
Treatment z Administer y Nifedipine 5mg crush and swallow y Or GTN 300Micrograms/nasal spray (Only if diastolic BP is greater than 100mmHg) Patient should have a supply
z If this is unsuccessful and cause is not found inform a Dr/GP/go to ED as Phentolamine 510mg IV may be required
z Time will be running out
Rehabilitation Process
zAssessment zEducation
⌧Patient, Family, Friends, Carers, ⌧Lesson Plan ⌧Skills development ⌧Skills assessment ⌧Independence ⌧Teaching others
Rehabilitation Process
zDeveloping skills ⌧Recognition ⌧Self assessment – find cause ⌧When to take medication ⌧Change catheter ⌧Bowel care ⌧Skin inspection
zMonitoring ⌧Care plan ⌧Diary
AD Diary
z This diary is intended for you to use and keep as a record of your episodes autonomic dysreflexia. The intention is not for you to keep records indefinitely, but until you feel confident in your ability to recognise your symptoms together with any trends in the causes to help you to prevent further episodes.
z Name: z Level of SCI …………………. Complete Incomplete Date of
SCI …………… z Normal BP…………/…………….
Date of Autonomic Dysreflexia episode ………………………..
Symptoms: Put an ‘X’ in the box of all the symptoms you experienced.
q Pounding headache q Heavy sweating q Blurred vision q Tight chest q Blotchy/flushed skin above SCI q Goose bumps q Anxiety/fear q Difficulty breathing q Other:
z Cause: Comments:…………………………..…………………..
z Did you need medication? Yes No zWhat did you take? ………... Dose(s) ……………….
z Did you have any difficulties managing the episode? q Yes q No
z Comments: …………………….………………………..
AD Kit
It is advisable to carry suitable equipment z going out z on holiday
If you out and unable to find a suitable place to manage an episode of AD call 999 for help.
In your local area HAVE A PLAN.
Catheter Supplies
z Hand wipes or gel z Syringe to remove catheter if using an indwelling catheter
z Spare catheter correct size z Bladder syringe z Insertion supplies including hand wipes and gloves z Sterile syringe to put water into the balloon, sterile water
z Disposal bag z Spare clothing if you usually bipass the catheter/leak
Bowel Care Supplies
z Latex gloves z Polyethylene gloves z Anaesthetic lubricating gel zWet wipes (baby wipes), tissues z Disposal bag z Spare clothing